Determining criteria for shunt placement during carotid endarterectomy. EEG versus back pressure

EEG monitoring and carotid back pressure were performed on 100 patients undergoing elective carotid endarterectomy. Shunts were inserted selectively in those patients who showed change in EEG after a trial period of carotid clamping (15%). No patient in the series awoke with a neurologic deficit. Back pressures were significantly lower in the shunted group and these pressures roughly correlated with EEG changes. Only one patient with a back pressure of greater than 40 mmHg had EEG changes and this patient had a recent mild stroke. EEG changes were most frequent in patients with contralateral carotid occlusions and in asymptomatic significant stenoses. EEG is a more discriminating indicator for shunt insertion than back pressure, although a pressure greater than 40 mmHg is safe in patients without recent stroke.